MEDICARE: PROSPER PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1841888054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPER PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	20810 ODELL CT N
Second Line	:
City	:	SCANDIA
State	:	MN
Zip	:	55073-6400
Country	:	US
Telephone Number	:	612-718-2669
Fax Number	:

Provider Business Practice Location Address
First Line	:	168 LAKE ST S STE C
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2676
Country	:	US
Telephone Number	:	612-718-2669
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	AMY GOEHNER
Credential	:
Telephone Number	:	612-718-2669

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	02/06/2026

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